01 January 2013

Research: The Royal College of Physicians' new year's fat hate fest

The predictable new year dose of fat panic kicked off today with widespread reporting of the Royal College of Physicians' (RCP) latest missive, complete with a plethora of headless fatties from the picture archives. The RCP is a charity that represents physicians and, according to its website, "takes a wide role in public health". Action on obesity: Comprehensive care for all, by one of the RCP's working parties, states that the current response to obesity by the NHS is "patchy" and could be resolved by a number of proposed initiatives.

Reading the report is like a journey into Opposite Land. The work is well-meaning, but it exists with a framework that is profoundly problematic. For example, it is hard to disagree that current service delivery for fat people is really poor, particularly for those who undergo weight loss surgery, and that there needs to be proper auditing, quality control and monitoring of all obesity treatments.

But the report, as is typical in a medicalised discourse of fat, is entrenched in a view that regards weight loss as the universal solution to the problem of fat people and health. The authors throw about "severe complex obesity," a term they're obviously pretty proud of, coming soon to a healthcare provider near you, and bound to further medicalise and stigmatise fat people. They make the crucial mistake of failing to question the effectiveness of weight loss at all, so it's not weight loss surgery that ruins fat people's health, it's the fact that the care pathways surrounding the surgery need tweaking. This ties them up in all kinds of knots, looking for answers in the wrong places, for example suggesting that the UK needs a Michelle Obama figure to galvanise the population against obesity, even though her crusade in the US has been disastrous in re-stigmatising fat kids, and even though we've already seen Jamie Oliver screw things up over here.

The report, its press release, and subsequent reporting, reiterates the usual stale fat panic rhetoric about demographics and increasing body weight, and reproduces the inconsistencies of this argument. An estimated cost of £5 billion per year is placed on 'obesity', based on secondary reports, all of which also estimate the cost or propose costs based on irrelevant evidence (I checked their methodology). This figure is therefore a fantasy. More confusingly, Action on obesity: Comprehensive care for all criticises these costs, whilst making a prolonged case for spending more on obesity treatment, presumably because that's what puts the bread and butter in its members' tables. It's nonsense.

This report is an example of obesity research which eschews a research justice framework – more about that in posts to come – but which makes a big honking noise about being for the benefit of humanity. But work like this, cynically capitalising on new years anxiety about fat, is a load of hot air, a waste of space, that serves no one but the members of the RCP, least of all fat people.

If the RCP were really serious about fat people's health, they would be investing in health at every size research, developing fat activist communities, and pioneering projects such as medical self-advocacy, anti-discrimination work, and other low cost, low risk initiatives that have proven track records in increasing fat people's well-being. But that's just crazy talk, isn't it?